Speaker: Stemless humeral prostheses require correct head size, positioning
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KOLOA, Hawaii — Stemless humeral prostheses offer biomechanical and clinical benefits, however proper positioning and size are critical, according to a presenter at Orthopedics Today Hawaii.
“Here is my model: stemless humeral prosthesis, unless you can’t,” Anthony A. Romeo, MD, said here. “You don’t need a stem. It is something that has been there for a long time, but you don’t need it. So, if you don’t need it, why do you put it in?”
He said the design principle of primary stability is achieved by shifting the fixation of the trunnion close to the center of rotation. There are a variety of different stemless devices that are available around the world, including the United States.
“Not all stemless and short stems are equal. Make sure you know your system. Make sure understand putting the head in exactly the right spot,” he said.
Romeo said stemless prostheses offer preservation of humeral shaft bone, are independent of the humeral shaft, have ease of glenoid reconstruction, decrease blood loss and pain and allow for easy revision. Additionally, the prostheses can facilitate outpatient arthroplasty. Correct head size and position are critical, and some short stems may lead to stress shielding.
Good outcomes are seen in short stem and stemless implants, Romeo said.
The challenges of stemless humeral replacement are tendency to overstuff, subscapularis fixation and the tendency to varus cut, he said.
“It is not about the stem. It is about the humeral head being in the right spot and keeping it in the right spot. And you can do that with a stem, but why?” he said. by Kristine Houck, MA, ELS
Reference:
Romeo AA. Stemless arthroplasty update at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Romeo reports he receives royalties from Arthrex and Elsevier; is a consultant for Arthrex and Paragen Technologies; receives miscellaneous support from Arthrex; and receives basic science/research support from Arthrex and Northwell Health.